Healthcare Provider Details

I. General information

NPI: 1649415704
Provider Name (Legal Business Name): REX SPECIALTY PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CENTRAL CT
VALLEY STREAM NY
11580-1143
US

IV. Provider business mailing address

48 CENTRAL CT
VALLEY STREAM NY
11580-1143
US

V. Phone/Fax

Practice location:
  • Phone: 516-593-7747
  • Fax: 516-593-7094
Mailing address:
  • Phone: 516-593-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029168
License Number StateNY

VIII. Authorized Official

Name: DR. ALI HASSAN JAFFERY
Title or Position: PRESIDENT/SUPERVISING PHARMACIST
Credential: PHARM.D
Phone: 516-593-7747